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Home My WebLink AboutBLDG-23-001848 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 06,2022 PERMIT# BLDG-23-001848 JOBSITE ADDRESS 80 ROUTE 28 OWNER'S NAME KRASION LLC G OWNER ADDRESS C/O MESIALIDES KONSTANTIA 128 GLENEAGLE DR CENTERVILLE MA 02632 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR 2 FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 2 POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Robert Lalime LICENSE# 13701 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: BCL PLUMBING ADDRESS. 575 Main Street, CITY Mashpee STATE MA ZIP 02649 TEL FAX CELL 5082920374 EMAIL none _ IIJ&A 9f A; s e7A -'� I MASSACHUSETTS UNIFORM APPLICATION FOR A PER IT O PERFORM GAS FITTING WORK CITY y A oe j C/ ,V MA DATE (42 5 z2 PERMIT#Z 3— a(17 JOBSITE ADDRESS Bo 4 t Cl— t1 28 OWNER'S NAME C��l _C 44o--,_ GOWNER ADDRESS TEL- 36('(-67gl d'r( FAX TYPE PRI OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW: RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION-BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYC)LATOR Z. _ FURNACE. GENERATOR GRILLE INFRARED HEATER i LABORATORY COCKS - - . MAKEUP AIR UNIT OVEN 2 �T- 22 - 1 POOL HEATER . ROOM/SPACE HEATER tau LurtvC�iDLr'' FAT►vi iT ROOF TOP UNIT sr L TEST . UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSUANCE GE I have a current liability insurance policy or its substantial equ va et nwhi h meets the requirements of MGL.Ch.142 YES 6 NO CI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY El BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waves this requirement. - CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur- /< c . 9 9 PP eat my of thknowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance wi ..-r- �� Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� sion of the ��ve. - 137 0 ( 51GNATURE MP l MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME 11? ( (� i I)Co Mt•6 (hr (-' ADDRESS $15 `t 5 CIT Y t o 14�dC& STATE Ath ZIP CD 24 ( TEL FAX CELL 503- 212-031Y EMAIL 0046 7